Symptoms of Advanced Congestive Heart Failure

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Congestive Heart Failure Demystified

Though the heart is popularly associated with love and romance, in reality it performs a very mundane but extremely vital function for the body – pumping oxygenated blood to all other organs. Their very survival and functioning hence depends on the heart’s beating. As the name suggests, congestive heart failure (or CHF) occurs when the heart is unable to do this function properly. The heart weakens and does not efficiently pump blood, thereby reducing oxygen available to all the other organs of the body. Fluid backs up in the lungs, further reducing the heart’s efficiency. The kidneys get affected next and do not remove excess fluid from the body, leading to accumulation of fluids in extremities, particularly the legs. The situation progressively worsens till the heart fails altogether to pump any blood.

The ‘congestion’ caused due to the fluid accumulation lends its name to the syndrome – congestive heart failure. As this disease develops over time, recognizing the symptoms of advanced congestive heart failure could very well save the life of you or your loved ones.

So What Causes CHF?

As mentioned earlier, CHF occurs when the heart does not pump blood efficiently. This is due to weakening of the heart muscles. There are various reasons why this may occur:

  1. The most common reason is coronary artery disease, a syndrome where the blood vessels supplying heart muscles with blood get clogged, thereby depriving them of oxygen, causing weakness and inefficient functioning.
  2. Damage due to an earlier heart attack, high blood pressure, history of fibrillation, chronic kidney disease, conditions like rheumatic fever causing damage to heart valves or infections of the heart muscles/endocarditis may lead to this condition.
  3. People who are obese or suffering from diabetes are much more prone to CHF than others.
  4. There are also known cases of certain post-operative complications leading to CHF over a period of time.
  5. Genetics also plays a role and certain congenital syndromes are known to lead to CHF in children.

Recognizing the Symptoms of Advanced Congestive Heart Failure

Our body is very dynamic, and the heart tries its best to cope with the situation before showing any tell-tale symptoms. Initially the heart size increases, as it tries to accommodate increased demand. This leads to stretching of the muscles, which progressively weaken over time. The heart rate also increases, and one can start feeling this as decrease in energy or stamina, breathlessness or palpitation on exerting even slightly.

The New York Heart Association (NYHA) Functional Classification places patients in four categories depending on how much their physical activity gets affected:

  • Class I - asymptomatic with no hindrance to any physical activity.
  • Class II - normal while at rest, but slight limitations to physical activity.
  • Class III - Marked limitation in activity due to symptoms, even during less-than-ordinary activity, comfortable only at rest.
  • Class IV - symptoms are experienced even when at rest.

As damage to heart muscles in permanent and irreparable, it makes great sense to err on the side of caution and pay a visit to the doctor if you or your loved ones exhibit more than three of the following symptoms of advanced congestive heart failure:

  1. Unusual fatigue and weakness along with increased heart rate (tachycardia), generally for longer periods of time. Advanced congestive heart failure patients experience almost unbearable fatigue, which continues over long periods of time.
  2. Accumulation of fluids, or edema, which is often recognized by swelling in the abdomen, feet and ankles.
  3. Due to this, the heart finds it increasingly difficult to perform, leading to shortness of breath (dyspnea), with an advanced scenario being shortness of breath even when lying down (orthopnea).
  4. The fluid accumulated in the abdomen leaves one feeling bloated, often leading to loss of appetite. Weight gain in spite of poor appetite and often over a short period of time, is one of the indicators.
  5. Fluid backing up in the lungs leads to respiratory illnesses like a persistent cough, with mucus tinged pink (due to blood) or severe wheezing.
  6. A general feeling of being disoriented or loss of memory.
  7. In some patients, these symptoms can be accompanied with high blood pressure and a reduction in urine.

Do remember that timely identification of these symptoms can be the difference between life and death!


American Heart Association (

University of Virginia Health System (

The Lancet, Volume 365, Issue 9474, Pages 1877 - 1889, 28 May 2005